The state of sisu

Warning: self-indulgent navel gazing ahead.

I've been thinking about sisu lately - so, apparently, have Forbes and the Toronto Observer - and what it means to live sisu. Sure, I'm stubborn. I keep running, even after more than a year off due to chronic migraines and daily pain. Every day feels like a performance of the ultra-runner's motto "relentless forward progress." My brother the Marine called me Iron Mel in his birthday text last week and said he thought I was tough as nails.

But sisu is more than grim determination or tenacious endurance - it's "a consistent, courageous approach toward challenges which at first seem to exceed our capacities."* Living sisu means more to me than sucking it up every day and waking up the next day to do it again. Living sisu means finding a way to do it better. To keep searching for effective treatments, keep running, keep training.

How? I got some help:

• I found a new headache specialist, and I'm exploring some unconventional treatments.
• I got a coach, who is awesome and fun and has a group of amazing athletes.
• I wrote down some super-secret goals (which I'm not sharing yet because, yeah, super secret). 
• I restarted this blog to keep me focused and honest and looking forward.

And I'm working on framing my ideas and experiences in a way that supports my goals - seeing adversity as experience that builds resilience. That's the state of sisu around here.

*As described by sisu researcher Emilia Lahti in her master's thesis Above and Beyond Perseverance: An Exploration of Sisu.

Pain is an asshole screaming in your ear.

You do what you can to get him to go scream in the next room, or even outside the house. If you're lucky, you can close the windows, turn up some music or read a book, and ignore him.*

But he's still an asshole. He'll be back, screaming at you, in a few hours, even if you didn't do any of the things that piss him off, like sleeping too much or not enough, or eating the wrong things. Even if you do all the right things, even if he stays outside for a few days or weeks (or months, if you're really lucky), he's still coming back.

Chronic pain, like any asshole, is mean and petty and sneaky. It'll take things from you - your sleep, your social life, your humor, your sanity. It doesn't care if you have commitments or goals - schedules mean nothing. Invisible to most, impossible to objectively measure, stubborn as hell.

At best, chronic pain is utterly useless. It's not a warning sign that something's gone wrong, like the pain that comes with a running injury. It IS the thing that's gone wrong. Pain begets pain begets pain, setting off a cascade of negative effects:

"''Chronic pain uses up serotonin like a car running out of gas...If the pain persists long enough, everybody runs out of gas.'' Thus...not treating ...pain aggressively because [the patient is] ''tense'' is like ''not rescuing someone who is drowning because they're having a panic attack.''...Difficulty breathing triggers panic as reliably as pain causes depression. When serotonin is inhibited in laboratory animals, morphine ceases to have an analgesic effect on them. Medications that treat depression also treat pain. Depression or stressful events can in turn enhance pain.''**

You can't hide from chronic pain - my own particular asshole has been screaming for 20 years now. I'm still trying to figure out how to keep the volume down. What I have learned is that there are things I can do that make it easier to live with the pain. They won't necessarily make the pain any better (though not doing them will probably make the pain worse), but they help me feel better even when I'm hurting - running is one of these things. 

There's some evidence that exercise can help people cope better with chronic pain - the idea is that while athletes aren't less sensitive to pain, they've just learned how to put up with more of it longer. But what if it also goes the other way? What if having chronic pain helps you deal with pain from training or racing hard because you already know how to live with pain? Might the flip side of “athletes can just stand more of it longer” be that people with some types of chronic pain might succeed as endurance athletes?

My theory is that pain from racing or training is a choice - it's pain I choose to feel, rather than the pain I live with that's beyond my control. Exercise might improve pain tolerance and reduce depression & anxiety (physiologic consequences of chronic pain that also increase sensitivity to pain - there's that asshole again). For me, hard training and racing provide a temporary escape from constant pain. It's still there, still screaming, but I'm running outside.

*Credit for this metaphor to Alexandra Lynch, Daily Kos commentor
**Melanie Thernstrom, Pain, the Disease, New York Times, 12/16/2001